Current Events in Mental Health

Fairbanks Court's Treatment of Mentally Ill Spurs New National Position Statement

In response to a member complaint about Alaska judges shackling and transporting mentally ill inpatients to court in police vehicles, the American Psychiatric Association is developing a Position Statement to guide civil commitment courts in the respectful treatment of people with severe mental illness.

For more than a decade, Alaska’s Fourth Judicial District, based in Fairbanks, has maintained a policy that requires civil commitment respondents be transported from Fairbanks Memorial Hospital to the downtown courthouse in the same manner accused criminals are transported to jail. Fourth Judicial District policy explicitly states that mentally ill patients are to be transported to “best serve the convenience of the court and counsel.” However, Alaska Psychiatric Association members have long maintained that treating disabled people like criminals is harmful.

Although the court’s policy permits civil commitment hearings to be held at the hospital under extenuating circumstances, Joshua Sonkiss, MD, former Medical Director of Fairbanks Memorial Hospital’s Behavioral Health Unit, says that in practice it is very difficult to convince the court to change hearing location unless a patient is suffering from severe physical illness in addition to mental illness. “The court recognizes physical disabilities as real illnesses,” Dr. Sonkiss stated, “but it ignores the potential for psychological harm its policy inflicts on people with mental illness.”

According to Dr. Sonkiss, Fourth Judicial District judges have ignored years of advocacy by local psychiatrists to make the hospital the default location for civil commitment hearings. In a 2014 letter to the court, Dr. Sonkiss wrote that shackling and transporting severely mentally ill individuals “can only be described as a decision to dehumanize, stigmatize and terrorize people for no other reason than that they are mentally ill and cannot defend themselves.”

Dr. Sonkiss advocated that patients be transported to court only for overriding safety concerns or if that is the patient’s preference. However, Dr. Sonkiss said the Fourth Judicial District remains committed to its current policy of transporting patients in shackles. “The court never consulted with mental health experts in developing its current policy,” Dr. Sonkiss stated, “and its refusal to change the policy suggests it does not take patients’ psychological suffering seriously.”

After the court failed to change its practices, Dr. Sonkiss took the issue to the APA Assembly in Washington, D.C. There, he received unanimous agreement from APA leaders that a national Position Statement is needed to guide courts in treating people with mental illness with respect and dignity. The APA’s Council on Psychiatry and Law is currently developing the Position Statement, which is expected to contain several recommendations for humane treatment of mentally ill individuals by civil commitment courts. APA position statements may be found here.

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